Summary
The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or ...osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.
Introduction
To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.
Methods
We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.
Results
The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1–17 years). The use of BPs was significantly associated with AFFs (
p
< 0.001, odds ratio = 25.65; 95% confidence interval = 10.74–61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.
Conclusions
The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.
Hand/upper extremity transplantation is the most common form of vascularized composite allotransplantation performed to date. An Update of worldwide outcomes is reported.
The authors summarize the ...international experience with 107 known transplanted hand/upper extremities in 72 patients. Data from published medical literature, national and international meetings, lay press reports, and personal communications were utilized to provide the most up-to-date summary.
Although 24 losses (including four mortalities) are known, three of the four reported mortalities and eight of 24 limb losses were caused by multiple type vascularized composite allotransplantations (combined upper and lower limb or upper limb and face). Seven more losses were attributable to 15 patients in the early experience in China. In the United States and Western Europe, only three other non-acute graft losses have been reported, resulting in a patient survival rate for unilateral or bilateral hand transplantation in isolation of 98.5 percent and an overall graft survival rate of 83.1 percent.
Published functional outcomes continue to demonstrate improvement in function and quality of life. The international experience supports the idea that, for properly selected individuals, hand and upper extremity transplantation should be considered an important treatment option.
To evaluate the efficacy and safety of tabalumab, a human IgG4 monoclonal antibody that neutralises membrane and soluble B-cell activating factor (BAFF).
This randomised, placebo-controlled study ...enrolled 1124 patients with moderate-to-severe systemic lupus erythematosus (SLE) (Safety of Estrogens in Lupus Erythematosus National Assessment- SLE Disease Activity Index ≥6 at baseline). Patients received standard of care plus subcutaneous study drug, starting with a loading dose (240 mg) at week 0 and followed by 120 mg every 2 weeks (120 Q2W), 120 mg every 4 weeks (120 Q4W) or placebo. Primary endpoint was proportion achieving SLE Responder Index 5 (SRI-5) improvement at week 52.
Clinical characteristics were balanced across groups. The primary endpoint was met with 120 Q2W (38.4% vs 27.7%, placebo; p=0.002), but not with the less frequent 120 Q4W regimen (34.8%, p=0.051). Although key secondary endpoints (time to severe flare, corticosteroid sparing and fatigue) were not met, patients treated with tabalumab had greater SRI-5 response rates in a serologically active subset and improvements in more stringent SRI cut-offs, SELENA-SLEDAI, Physician's Global Assessment, anti-double-stranded DNA antibodies, complement, total B cells and immunoglobulins. The incidences of deaths, serious adverse events (AEs), and treatment-emergent AEs were similar in the 120 Q2W, 120 Q4W and placebo groups, but depression and suicidal ideation, albeit rare events, were more commonly reported with tabalumab.
SRI-5 was met with 120 Q2W and although key secondary endpoints were not met, numerous other secondary endpoints significantly improved in addition to pharmacodynamic evidence of BAFF pathway blockade. The safety profile for tabalumab was similar to placebo, except for depression and suicidality, which were uncommon.
NCT01205438.
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA ...refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify. Despite encouraging functional outcomes, current immunosuppressive regimens with their deleterious side-effect profile remain a major concern for a life-changing but not life-saving type of transplant. In addition, a growing number of recipients with progressively longer follow-up prompt the need to investigate potential long-term sequelae, such as chronic rejection. This review will discuss the current state of HUET, summarizing outcome data on graft survival, motor and sensory function, as well as immunosuppressive treatment. The implications of these findings for VCA in terms of achievements and challenges ahead will then be discussed.
In recent years, instrumentation enabling pulsar observations with unprecedentedly high fractional bandwidth has been under development which can be used to substantially improve the precision of ...pulsar timing experiments. The traditional template-matching method used to calculate pulse times of arrival (ToAs) may not function effectively on these broad-band data due to a variety of effects such as diffractive scintillation in the interstellar medium, profile variation as a function of frequency, dispersion measure (DM) evolution, and so forth. In this paper, we describe the channelized discrete Fourier transform method that can greatly mitigate the influence of the aforementioned effects when measuring ToAs from broad-band timing data. The method is tested on simulated data, and its potential in improving timing precision is shown. We further apply the method to PSR J1909−3744 data collected at the Nançay Radio Telescope with the Nançay Ultimate Pulsar Processing Instrument. We demonstrate removal of systematics due to the scintillation effect as well as improvement on ToA measurement uncertainties. Our method also determines temporal variations in DM, which are consistent with multichannel timing approaches used earlier.
Wintertime ammonium nitrate aerosol pollution is a severe air quality issue affecting both developed and rapidly urbanizing regions from Europe to East Asia. In the United States, it is acute in ...western basins subject to inversions that confine pollutants near the surface. Measurements and modeling of a wintertime pollution episode in Salt Lake Valley, Utah, demonstrate that ammonium nitrate is closely related to photochemical ozone through a common parameter, total odd oxygen, Ox,total. We show that the traditional nitrogen oxide and volatile organic compound (NOx‐VOC) framework for evaluating ozone mitigation strategies also applies to ammonium nitrate. Despite being nitrate‐limited, ammonium nitrate aerosol pollution in Salt Lake Valley is responsive to VOCs control and, counterintuitively, not initially responsive to NOx control. We demonstrate simultaneous nitrate limitation and NOx saturation and suggest this phenomenon may be general. This finding may identify an unrecognized control strategy to address a global public health issue in regions with severe winter aerosol pollution.
Plain Language Summary
Particulate matter (PM) is dangerous to human health and impacts visibility and climate. In the United States, Europe, and Asia, PM is severe in urban areas in the winter when ammonium nitrate, NH4NO3, comprises an appreciable fraction of the total PM mass. A key control strategy is to reduce emissions of the limiting reagent. Using measurements from a recent field campaign in the Salt Lake Valley, Utah, which experiences high PM levels in winter, we demonstrate that emission control strategies can be evaluated using the same framework commonly used to control ozone, another common pollutant that occurs at high levels in urban areas in the summer. We show that initial control of the NOx precursor is ineffective at reducing NH4NO3 aerosol in the Salt Lake Valley, while initial control of volatile organic compounds, which are not a direct precursor for either nitrate or ammonium, is effective due to their influence on oxidation cycles. This finding differs from many mitigation strategies in the western United States and may also be relevant to other regions in Europe and Asia which experience high wintertime PM.
Key Points
Wintertime ammonium nitrate aerosol pollution is closely tied to photochemical ozone production through a common parameter, Ox,total
Box modeling reveals ammonium nitrate formation in the Salt Lake Valley is nitrate‐limited but NOx‐saturated
Mitigation strategies that focus on NOx control in some wintertime‐polluted layers may initially increase ammonium nitrate
The ability to replace organs and tissues on demand could save or improve millions of lives each year globally and create public health benefits on par with curing cancer. Unmet needs for organ and ...tissue preservation place enormous logistical limitations on transplantation, regenerative medicine, drug discovery, and a variety of rapidly advancing areas spanning biomedicine. A growing coalition of researchers, clinicians, advocacy organizations, academic institutions, and other stakeholders has assembled to address the unmet need for preservation advances, outlining remaining challenges and identifying areas of underinvestment and untapped opportunities. Meanwhile, recent discoveries provide proofs of principle for breakthroughs in a family of research areas surrounding biopreservation. These developments indicate that a new paradigm, integrating multiple existing preservation approaches and new technologies that have flourished in the past 10 years, could transform preservation research. Capitalizing on these opportunities will require engagement across many research areas and stakeholder groups. A coordinated effort is needed to expedite preservation advances that can transform several areas of medicine and medical science.
Mica nanosheets possess peculiar feature of narrowed bandgap with the decrease of thickness but a conclusive theoretical understanding of the narrowing mechanisms is still under development. In this ...report, first-principles calculations were carried out to investigate the electronic band structure of mica nanosheets with the deposition of K
CO
. Bulk mica shows an indirect bandgap of 4.90 eV. Mica nanosheets show similar electronic structures to bulk mica with a gradually increased bandgap of 4.44 eV, 4.52 eV and 4.67 eV for 1-layer, 2-layers and 3-layers nanosheets, respectively, which is attributed to the lattice relaxation. K
CO
is found to have strong affinity towards mica nanosheets. The K
CO
deposited mica nanosheets showed an increased bandgap with the increase of thickness, consistent with experimental observations. The calculated bandgap of K
CO
deposited mica for 2-layers and 3-layers nanosheets are 2.60 eV and 2.75 eV, respectively, which are comparable with the corresponding experimental values of 2.5 eV and 3.0 eV. Our theoretical findings support the experimental evidence of surface contamination of mica by K
CO
, and provide new insight into the structure and properties of 2D mica.
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